| Surgery Center Of Penthouse Iv | |
|
101 Old Short Hills Road West Orange NJ 07052 | |
| (973) 736-1345 | |
| (973) 325-3487 |
| Full Name | Surgery Center Of Penthouse Iv |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 101 Old Short Hills Road, West Orange, New Jersey |
| Authorized Official Name and Position | Theodore A Niebloom (DOCTOR ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 9737367616 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Surgery Center Of Penthouse Iv 101 Old Short Hills Road West Orange NJ 07052 Ph: (973) 736-1345 | Surgery Center Of Penthouse Iv 101 Old Short Hills Road West Orange NJ 07052 Ph: (973) 736-1345 |
| NPI Number | 1710060496 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710060496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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